MEDICARE: DR. SHARMILA SRINIVASAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0107X	Retina Specialist (Ophthalmology) Physician	281438	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174285365	OTHER	MA	NPI

General Provider Information

NPI Number	:	1033386057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARMILA SRINIVASAN M.D.

Provider Business Mailing Address
First Line	:	1 PEARL ST STE 1300
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-2867
Country	:	US
Telephone Number	:	508-232-3222
Fax Number	:	508-510-4774

Provider Business Practice Location Address
First Line	:	1 PEARL ST STE 1300
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-2867
Country	:	US
Telephone Number	:	508-232-3222
Fax Number	:	508-510-4774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	01/08/2022

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